ObjectiveTo systematically review the effectiveness and safety of anatomic landmarks positioning method (ALM) and real-time two-dimensional ultrasound (RTUS) guidance in the internal jugular vein cannulation. MethodsWe searched PubMed, EMbase, Web of Knowledge, CBM, WanFang Data and CNKI for randomized controlled trials (RCTs) concerning the effectiveness and safety of ALM and RTUS in the internal jugular vein catheterization up to May 1st, 2014. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assess methodological quality of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 10 RCTs involving 1 973 cases were included in the metaanalysis. The results of meta-analysis showed that, compared with the ALM method, the RTUS method reduced puncture failure rate (OR=0.08, 95%CI 0.05 to 0.15, P<0.000 01). For safety, compared with the ALM method, the RTUS method was significantly lower in arterial injury rate (peto-OR=0.22, 95%CI 0.14 to 0.37, P<0.000 01), and the incidence of pneumothorax (peto-OR=0.13, 95%CI 0.04 to 0.40, P=0.000 3). ConclusionCompared to the ALM method, the RTUS method has characteristics such as causing fewer traumas, and having higher success rate and fewer complications. Due to limited quantity and quality of the included studies, the above conclusion still needs to be verified by conducting more studies.
ObjectiveTo evaluate the ultrasonic pre locating internal jugular venous cannulation in infants, comparison with the external landmark technique.MethodsSixty two infants scheduled for cardiac surgery were randomized prospectively into two groups. In the anatomic landmarks group( n =30), the patient’s internal jugular vein(IJV) were cannulated by using the traditional method of palpation of carotid pulsation and identification of other anatomic landmarks. In the ultrasonic pre locating group ( n =32), an two dimensional ultrasound scanner image made for locating the puncture site of vessels was used with an operative probe of HP SONOS 4500 system. The number of attempts, success rate, and incidence of complications were compared for two groups.ResultsThe success rate was 100% vs 80% in the ultrasonic pre locating group vs anatomic landmarks group, with a 3.1% vs 26 7% incidence of carotid artery punctures and the number of attempts 1.57±1.04 vs 2.55±1.76. All differences were statistically significant ( P lt;0.05,0.05,0.01). Conclusion Ultrasonographic pre-localization of the IJV is superior to the anatomic landmarks technique in terms of overall success , and decreases incidence of carotid artery puncture.
ObjectiveTo explore the key points, indications and safety of trans-jugular transcatheter closure of atrial septal defect (ASD) in infants.MethodsThe clinical data of 53 infants with ASD from January 2017 to May 2019 in our hospital were retrospectively reviewed. There were 20 males and 33 females with the age of 1.2 (0.5-2.9) years, and body weight of 9.0 (6.8-10.6) kg. The ASD diameter was 9.8 (8.0-14.0) mm. Thirty-one patients were treated under the guidance of transesophageal ultrasound (TEE), and the other 22 patients under the guidance of transthoracic echocardiography (TTE). We used the steerable curved sheath through the internal jugular vein under the guidance of echocardiography, and the average occluder size was 13.5±4.5 mm.ResultsAll of the 53 patients were successfully occluded, and none of them changed to radiation-guided or transthoracic surgery. Postoperative hospital stay was 3.35±0.70 d. There was no complication such as peripheral vascular injury, occluder malposition or displacement, serious arrhythmia or pericardial effusion. The patients were followed up for 14.3±5.1 months without arrhythmia, residual shunt, occluder malposition or displacement or thrombus.ConclusionEchocardiography-guided trans-jugular closure of ASD for infants with low weight and large ASD shunt or patients with inferior vena cava abnormalities not suitable for femoral vein treatment, not only overcomes the radiation risk of radiation guidance, but also maintains the advantages of minimal invasiveness and safety, providing a new treatment option for such patients.
目的 讨论B型超声定位下颈内静脉穿刺置管的经验。方法 回顾我中心2008年11月至2009年4月期间采用B型超声定位行颈内静脉置管的286例患者的临床资料。结果 一次性穿刺成功率为99.3%(284/286),置管成功率为100%(286/286); 穿刺时间50 s~12 min,平均106.8 s; 带管时间5~64 d,平均13 d; 未出现血气胸、皮下血肿等并发症。结论 B型超声定位下颈内静脉穿刺操作简单、方便、安全,适用于各级别医院。在颈短肥胖,被动体位情况下,B型超声定位下置管优势大于传统的盲探法及彩色多普勒超声引导下置管法。
We reported a 54-year-old female patient with severe tricuspid regurgitation, who received mechanic valve in the mitral position 15 years ago. The patient’s Society of Thoracic Surgeons score was 8.27%, and was intolerant to open heart surgery, so she was recommended for transcatheter tricuspid valve replacement via right vena jugularis interna. The procedures were guided by echocardiography and X ray fluoroscopy on November 13, 2021, the prosthesis was implanted successfully, and the patient was recoved without any adverse events. After 1 month follow-up, her general condition was apparently improved.